Lung uptake of technetium 99m sestamibi: relation to clinical, exercise, hemodynamic, and left ventricular function variables

Abstract

Background: Technetium 99m sestamibi (2-methoxyisobutyl isonitrile [MIBI]) is a relatively new radiopharmaceutical with improved imaging characteristics for exercise myocardial perfusion studies compared with thallium 201. Although increased lung uptake of 201Tl has been shown to have important clinical significance, reflecting severity of coronary artery disease and left ventricular function, the factors affecting MIBI lung uptake are unknown. Therefore we examined the potential clinical, exercise, hemodynamic, myocardial perfusion, and ventricular function determinants of lung uptake of MIBI on exercise myocardial perfusion studies.

Methods and results: The study cohort consisted of 103 patients referred for evaluation of coronary artery disease with exercise MIBI myocardial perfusion imaging. All patients underwent both a standard 1-day rest-stress MIBI planar imaging protocol and rest echocardiography. With the anterior-view stress images obtained 1 hour after MIBI injection, regions of interest were drawn over peak lung and myocardial activities and a lung/heart ratio was calculated. Multivariate regression analysis was used to relate the lung/heart ratio to clinical, exercise and hemodynamic, myocardial perfusion, and echocardiographic left ventricular function scores. We found no significant relation between lung/heart ratio and any patient variable.

Conclusions: Unlike 201Tl, lung uptake of MIBI is not related to indexes of exercise, left ventricular dysfunction, or perfusion abnormalities. Thus MIBI lung uptake does not appear to have the same clinical significance as 201Tl lung uptake.